Effect of low level laser application at the end of surgery to reduce pain after tonsillectomy in adults

Tonsillectomy is among commonest otorhinolaryngologic surgeries. Many methods have been used to control post surgical pain, but despite it, pain is still one of the problems related to this operation. Recently, due to the non invasiveness of low level lasers, this modality has attracted attention. The purpose of this study is to evaluate the effects of low level laser irradiation at the end of surgery on reduction of pain after tonsillectomy in adults. In a clinical trial, 60 adult patients, candidates for tonsillectomy were randomly assigned to two groups, A and B, and both groups were anesthetized similarly by the same technique. At the end of surgery, in the case group, the tonsils' bed were irradiated by infrared laser with 980nm wavelength, 100Hz, 4J/cm[2] from the infra mandibular angle. In the control group, the tonsils' bed had laser therapy with a turned off probe. Following laser treatment, the patients were reversed and extubated and consciousness achieved, pain and odynophagia were assessed at 2, 4, 6, 8, 12 and 24h post surgery based on visual analog scale for pain [VAS] and analgesic consumption. In the laser group frequency of patients with pain sensation in each evaluated hour was lower than in the control group. The amount of pain decrease and analgesic consumption reduction was significantly higher in patients who received laser [P=0.01]. Based on the results of this study, use of low level lasers is effective in reducing tonsillectomy post surgical pain in adults

evaluation of the effect of morphine on abdominal pain and peritonealirritation signs in patients with acute surgical abdomen

Acute surgical abdomen is one of the most common emergency surgical causes all over the world and also one of the most important abdominal pain causes which is sometimes intolerable for the patients referring to the emergency departments. Diagnosis and planning for operation in these cases is based on time-demanding serial examinations and results of paraclinical data. In this waiting period, patients have to tolerate pain. Therefore, we aimed to study the hypothesis that relieving pain has no influence on valuable findings in physical examination. This double blind randomized clinical trial was carried out on 120 patients above 12 years old referred to an emergency department of a referral hospital with acute abdomen. Patients were divided into two groups of receiving intravenous placebo and Morphine randomly. Pain score, change in tenderness as well as change in rebound tenderness before and after receiving morphine or placebo were measured based on Numeric Pain Assessment Scale. Statistically significant difference was observed between both groups regarding the mean pain score. Prevalence of tenderness and rebound tenderness after medication administration revealed a significant difference between two groups. Furthermore, pain and tenderness showed a significant decrease in patients receiving morphine also a significant difference occurred in rebound tenderness between two groups. Despite the fact that opioid analgesics decrease pain in patients with acute surgical abdomen, they do not tend to eliminate required diagnostic data being obtained from physical examination like tenderness and rebound tenderness. Surprisingly, all the acute abdomen cases had rebound tenderness after morphine administration. Therefore, this research advises a cautious usage of morphine in patients with acute abdomen.

Multimodal preincisional premedication to prevent acute pain after cholecystectomy

Postoperative pain as an important medical concern is usually treated by opioids which also are of various inevitable side effects. The aim of this study was to assess the efficacy of multimodal preincisional premedication on preventing post-cholecystectomy acute pain. In a randomized clinical trial, sixty patients undergoing open cholecystectomy were randomized into two groups. Before anesthesia induction, Diclofenac suppository [100 mg] and oral Clonidine [0.2 mg] were administered in the first group. Immediately before operation, patients received Ketamine [1 mg/kg IV] while the control group received placebo. The site of incision was infiltrated by the surgeon with 20 mL Bupivacaine 0.25% in both groups. Anesthesia induction and maintenance were similar in both groups. The severity of pain was recorded 2, 4, 6, 12, 24 and 48 hours after operation according to Visual Analogue Scale. The severity of pain at two defined stages [6 and 12 hours later] was significantly less in the intervention group than the control group [P<0.005]. The average pain severity score was less than the control group [P<0.005]. In our study, the administration of Clonidine, Diclofenac and Ketamine and bupivacaine infiltration to the site of incision, altogether was associated with a significant decrease in pain score and opioid requirement after cholecystectomy in comparison to bupivacaine infiltration to the site of incision.